It’s Time to Confront Sexism in Medicine

I was told often at school that I was “very good at maths…for a girl.”

It’s been a long time since then. I believe that gender stereotypes in science and maths are a little less rife today. We cannot afford to become complacent though, as unconscious biases still exist.

Now, in my work as a doctor, antiquated comments crop up regularly.  Patients will mistake female doctors, residents and students for nurses. This happens regardless of how a female doctor introduces herself. The idea that a woman could only possibly be a nurse is clear evidence of the sexism that pervades society.

In spite of the steadily increasing proportion of women in medicine, the culture of medicine has not caught up. It’s well-documented that women are vastly underrepresented in leadership positions, such as full professors and department heads.

Stereotyping also exists within specialty programs. Many assume that the nature of the work demands detachment from emotions and an ability to withstand long hours and grueling procedures. To be tough, resilient and to soldier on have traditionally been thought of as male traits.

Even though the number of women taking up surgery has significantly risen in recent years, surgery is still very much a male-dominated field.

Sexism in medicine is deeply ingrained.

It is difficult for most young doctors to gain visibility and recognition. The situation is even more complex if you’re a young woman. Misogynist jokes and remarks about physical appearance or potential are obstacles that many have to deal with.

One challenge I have frequently faced is assumed incompetence. As a woman, I have had to fight for people to take me seriously. I hear doubts like ‘Can she provide medical care or take critical decisions when required?’ Often, a patient asks to see ‘the real doctor’. Translation? The male doctor.

There is no easy fix. On one side, you should not let any of the gender stereotypes thrown at you affect you. But neither can you ignore the bias.

The #MeToo movement has shined a light on the many places in our society where insidious or obvious sexism have long gone unremarked.

Medicine is no exception. There have been moments when I have been interrupted by an irrelevant comment and I have had to listen to sexist jokes. I have had to work hard to be heard and recognized. I’ve had to go the extra mile to earn the trust of patients, and even to identify with the scientific community.

I am learning that the most important thing is never to lose confidence. I try to stay focused on what’s important: doing great medicine.

What the medical profession needs is a drastic culture shift.

Sexist comments and inappropriate behavior in the medical field are evidence of a much larger problem. They show the insidious misogyny in our culture.

Doctors do not exist in a bubble. We are, to a large extent, products of our society. This includes people who make sexist jokes or commit sexual harassment. It also includes people who laugh along or accept sexism as normal. A shift this great requires courage and concerted efforts.

As one of the underrepresented populations in STEM, I believe I am making a difference simply by existing. I believe that it is really important to #balanceforbetter. We must put forward diverse, inclusive visions of the kind of future we would like medicine to create.

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Health Care Workers Matter for Gender Based Violence

It was 10:30 pm on a Monday night.

After a long day at work, I was preparing to go to bed. I usually read before I go to sleep and I’d been trying to finish one book for ages but other things kept coming up. I hoped and prayed tonight would be the night, but the universe had other plans – as always.

My cell phone beeped: “Doctor, it’s an emergency.’’ 

I flung myself out of the bed and tried to reach the hospital as quickly as I could. The patient was a married 27-year-old woman who had sustained major injuries after accidentally burning herself while cooking.

“60 percentage burn,” I deduced, after taking the patient’s history and a physical assessment. But somewhere inside, I knew this wasn’t an accident and I felt sure there was more to the story.

I started with the patient’s family members. Unsurprisingly, upon enquiry they maintained their stance and kept trying to convince me that their daughter-in-law burned herself while preparing the meal for the family. I decided to talk in confidence with the victim, but she was hesitant to break her silence too.

One day, over the course of providing her with routine care, the woman broke down into tears and alleged that her in-laws had set her on fire for dowry.

In a country like Nepal, speaking out about gender-based violence (GBV) is exceptionally difficult because of the shame, stigma and pressure from families and communities preventing victims from reporting abuse and seeking appropriate services.

Victims are often afraid of disclosing or reporting violence because of the consequences they fear will follow.

In turn, silence can aggravate the situation for survivors, leaving them with prolonged mental and physical suffering.

Nepal has a very high incidence of gender-based violence. And while everyone – regardless of gender – can be affected, women remain the main victims. It is difficult to understand the gravity of GBV in Nepal as many of these cases go unreported due to the silence maintained by victims and perpetrators.

GBV remains one of the most rigorous challenges to women’s health and well-being. It can take many different forms, like physical, sexual, emotional or psychological. The causes of gender based violence are multi-dimensional, and include social, political, economic, cultural and religious factors.

Dealing with survivors of GBV can be a very challenging and sensitive task; starting from acknowledging and identifying the violence to asking relevant questions, without being too intrusive or judgmental at all.

Like me, a wide range of health professionals are likely to come into contact with individuals who have experienced GBV. Health workers are in a unique position to help and heal the survivors of GBV, provided they have the knowledge to recognize the signs. Most of the time, health professionals are likely to be the first point of contact for GBV victims.

But are we, as health workers, equipped with the necessary skills to deal with GBV?

While staff and facilities play a key role in health delivery systems for GBV victims, their efforts will have limited impact unless there are specific policies on the issue of GBV to guide the integration of the response to GBV into health care.

One important approach is to specify the role of health care professionals, and to provide guidance and tools. For instance, the World Health Organization has developed guidelines for in-service training of health care providers on intimate partner and sexual violence against women, specifically. The guidelines are based on systematic reviews of evidence, and cover:

• identification and clinical care for intimate partner violence
• clinical care for sexual assault
• training relating to intimate partner violence and sexual assault against women
• policy and programmatic approaches to delivering services
• mandatory reporting of intimate partner violence

The guidelines aim to raise awareness of violence against women among health-care providers and policy-makers, so that they better understand the need for an appropriate health-sector response. They provide standards that can form the basis for national guidelines, and for integrating these issues into health-care provider education.

Sensitizing staff and building their skills on how to recognize and respond to GBV is crucial. Ensuring that services follow human rights-based and gender specific approaches, and are guided at all times by the preferences, rights and dignity of the victim, is important.

Providing adequate infrastructure to ensure the patient’s privacy, safety and confidentiality is also essential. This can be done by providing a private room for consultations, requiring that consultations are held without presence of a partner, putting in place a system for keeping records confidential or giving instructions to staff on explaining legal limits of confidentiality, if any.

Not only are health workers the ones to fix a fracture or heal a burn injury, they can also play the role of advocate by speaking up against injustice in the course of providing routine care.

Health professionals can also assist victims by making them aware of the counselling and legal services available, which is often a part of the recovery process. Gaining the trust of victims is important in this scenario. Community health care workers and midwives, who are often the most trusted members of societies, can use their power to reach women and vulnerable groups to encourage them to break their silence, and to make informed decisions about their bodies and lives.

The role of health professionals goes beyond simply treating and healing a survivor of gender bases violence – we can empower them, too.

Health Care is a Right, Not a Privilege

This month is the one-year anniversary of when the dangerous GOP Health Care Repeal Act (aka TrumpCare) passed the House of Representatives. Thanks to the voices of health care advocates from across the country, the bill ultimately failed in the Senate – but the threat of a GOP health care repeal is still alive.

Laura Packard is a health care advocate and Co-Chair of Health Care Voter based in Las Vegas, Nevada.

As well as being a political anniversary, May also holds personal meaning for me, because last year it was the month of my first chemo treatment.

Today I am a cancer survivor. I am also a woman. According to the 217 Republicans who voted for the bill, I deserve a lifetime of higher costs and more restrictions to lifesaving and necessary health care because I was sick and because I am a woman. 

If the Repeal Bill had passed, major sections of the Affordable Care Act (ACA, aka ObamaCare) would have been repealed. Millions of Americans would have faced higher hurdles when they needed to access health care – including me.

Just over a year ago I was diagnosed with stage 4 cancer, Hodgkin’s lymphoma. The treatments I received through the Affordable Care Act saved my life. The ACA prevented insurers from dropping people like me from any coverage, pricing it out of reach for people with serious medical conditions, or putting annual or lifetime limits on that coverage.

I’m a small business owner and so there is no insurance Plan B for me. If I cannot get coverage on the individual market, I cannot get insurance coverage at all. I am too young to be eligible for Medicare, and make too much money to be eligible for Medicaid. However, my treatment last year cost around a million dollars. I don’t have the money to pay that out of pocket, and almost all Americans could say the same.

Last year’s Health Care repeal bill was really just a tax break for millionaires, billionaires and wealthy corporations, paid for by the rest of us. If the GOP had their way, here’s what would have happened: the wealthiest one percent of Americans would have become even wealthier, while 23 million Americans would have lost their health insurance. Medicaid would have been cut by over $800 billion dollars.

In a world without protections for people with pre-existing conditions, I don’t know that I would be able to get health insurance at any price. That bill would not only have attacked my health care because of my pre-existing condition as a cancer survivor – it would have also punished me for being a woman.

Under the Republican plan, access to necessary and lifesaving women’s health care would have been cut. Health issues from ‘heavy periods’ to being a survivor of sexual assault could be labeled as pre-existing conditions – and insurers could charge women more than men for health insurance in general.

Last year, we fought back. We rallied. We protested. We called our lawmakers’ offices. But they didn’t listen.

President Trump blocked me on Twitter, Senator Heller did nothing as I was thrown out of his public forum for daring to ask about health care. But we stood strong and we stopped their votes on these dangerous pieces of legislation, again and again.

In the last year since this bill passed the US House, Republican attacks on our care have only continued. They have proposed new short-term ‘junk’ insurance plans (similar to ones I once relied upon!) that would have prevented patients from accessing essential health services. The disastrous TrumpTax passed in December will leave 13 million more Americans uninsured.

The Republican Party has not stopped threatening our health care and threatening our lives, even threatening yet another round of repeal efforts later this month. So it’s critical now that we don’t give up – we must keep our voices loud and tell our stories again and again.

If you’re in the US, sign the pledge to become a Health Care Voter, and pledge to hold our lawmakers accountable. Health care should be a right, not a privilege — and we will never stop fighting for it. Our lives depend on it.

Follow Laura on Twitter: @lpackard

#3 – Giving Birth in Sweden

In this episode of The Mom Pod, Julia Wiklander interviews midwives about the state of maternal health care in Sweden – a country that has been consistently ranked as one of the best places to give birth. She speaks with expecting parents about their preparations, fears and hopes for childbirth and tells the story of her own baby’s birth, together with her husband.

Mia Ahlberg, President of the Swedish Association of Midwives states the importance of having a woman centered care during pregnancy and childbirth.  “You always have to listen to her. You should never do anything without talking or asking her if she is comfortable with it. I think this is the most important part of midwifery”. Mia discusses the challenges that the Swedish maternal health care system faces, including limited space in hospitals, the refugee crisis and limited opportunities and choices for women.

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Maria and Kien who speak about their expectations of becoming parents in this episode of The Mom Pod.

Maternal health care in Sweden is centered around midwives, and they play an important and natural part of every pregnancy and birth. “Dare to ask your midwife!” encourages Liza Henning, midwife and Head of the Perinatal Department (BB) in Malmö, Sweden, which is her top tip to pregnant women and new mothers.

Sweden has become known for its generous maternity (and paternity) leave policy, and a strong welfare system boasting with free healthcare for all. In this episode you will also get an insight into how it is to be pregnant and expecting a child in Sweden.

Listen to the full episode below or on iTunes.

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Cover photo credit: La Citta Vita on Flickr.